Are You Putting Your Brain on the Front Lines?

She was the crush who rode away: tall, blond, and smart—the kind of woman you can’t take your eyes off. A stereotype? Maybe. But you’d understand if you saw her racing in a skinsuit.

I spent my freshman year of college fawning over her at bike races and doing the silly things guys do when wooing sexy sophomores. In the end, I got a single kiss on the cheek, and then she was gone—off racing in Europe. When she returned, though, she wasn’t the same. In the second stage of a race, on a road somewhere in Holland, she crashed. People said she flipped into a parked car and hit her head. Hard. That was it: her seventh concussion.

Sinead Miller hasn’t been right since.

There was a time when concussions weren’t feared. In fact, as recently as the 90s, many people didn’t even believe they affected your brain, says David Hovda, Ph.D., director of the Brain Injury Research Center at the University of California Los Angeles.

The research was out there: In the 1920s, doctors coined the term “punch drunk” to describe boxers who wobbled around as if drunk after suffering concussions. And in a landmark 1928 study, one researcher even wrote, “The condition can no longer be ignored by the medical profession or the public.”

But people wanted to ignore it—it was only a second-rate boxer’s problem. And as guys, we’ve been taught to shake it off. That’s what the biggest stars of the NFL and NHL do. They get up and walk away from even the most debilitating of hits to the head. In fact, 30 percent of hockey and 60 percent of football players admit to hopping back in the game after a head injury, according to a 2010 study of NCAA players. That number should be zero.

Concussions are hard to ignore these days—especially with studies like the 2012 Boston University one that autopsied the brains of 85 athletes with histories of concussions. It found that 80 percent showed evidence of chronic traumatic encephalopathy (C.T.E), a degenerative brain disease that causes memory loss, depression, and ultimately dementia. Among those found to have C.T.E were 33 former NFL players like Dave Duerson and John Mackey, six high school football players, nine college football players, seven pro boxers, and four NHL players. (We recently investigated C.T.E. in the Men's Health story Could Mike Webster’s Death Have Been Prevented?)

It’s that bad.

And it’s not just the pros or the hardcore athletes we need to worry about. Because children have big heads and weak necks, “youth brains are particularly vulnerable to brain trauma,” says the study’s coauthor and codirector of the Boston University Center for the Study of Traumatic Encephalopathy, Robert Cantu. The neurons in the brains of children aren’t fully sheathed in a myelin—a protective covering of cells—so they’re exposed to damage just like a telephone wire without a coating.

According to a 2012 study by researchers at Harvard Medical School, repeated minor head injuries may require us to rethink sports. After comparing the brains of 12 male soccer players with an average age of 19 who never suffered a concussion but regularly headed the ball to 11 concussion-free competitive swimmers, researchers reported potentially damaging changes in the areas of the brain responsible for memory and higher-level thinking in the soccer players.

Total brain trauma leads to long-term degeneration—and yet “the youngest players have the oldest equipment and the least experienced coaches,” according to Cantu. Few sports other than ice hockey (which has raised the age from 11 to 13 in which full-body checking is allowed) have made progress. And some doctors are still calling concussions “mild traumatic brain injuries” when, according to Cantu, “there’s nothing mild about it.”

Why? Maybe it’s because for 70 years, denial was the status quo, in part because nothing could be proved. In 1996, researchers noticed that the brains of people who suffered traumatic head injuries burned tons of glucose to “pump chemicals back to where they belonged,” Hovda explains. And though the findings were monumental—it was a sign of the damage they’d suffered—they couldn’t prove that concussions were causing the glucose burn.

Doctors were forced to treat patients based on symptoms, rather than the cause. The problem: Many diseases share similar symptoms. Forgetting someone’s name is a symptom of concussions, but it’s also something that just happens sometimes, says Geoffrey T. Manley, M.D., Ph.D., Chief of Neurosurgery at San Francisco General Hospital. Without an accessible brain scan, there’d be no way of knowing which is which.

Even the best neurologists aren’t that great at spotting concussions, Manley says.

The distinction between evaluating symptoms and making a diagnosis based on objective findings sounds trivial. It isn’t. I found out firsthand. After a particularly bad crash on a training ride 2 years ago, I was taken to the ER unable to feel the fingers on my left hand. My helmet was cracked, but the doctors weren’t concerned about a concussion. Why? I hadn’t blacked out. The problem is, you don’t need to black out to suffer from a concussion.

My coach, a grizzled veteran of European racing, convinced me to ask for more testing, so doctors scanned my head, and it changed their opinion—I “probably” had a concussion, they told me. (Will you really die if you fall asleep with a concussion? Discover 6 Concussion Myths.)

If Dr. Manley has his way, MRI testing like this would be the norm for people who’ve had multiple concussions, are considering quitting a sport, young children who’ve taken bad spills, or people with lingering symptoms but no way of knowing what damage their brains have suffered. In a 2012 study published in the Annals of Neurology, Dr. Manley found that MRIs detect concussions in 28 percent of people that CT scans miss.

Dr. Manley tells a story to get his point across: An NFL player who’d been in the game 8 years came asking for his opinion in light of his own injuries—should he retire or continue playing? After scanning the player, Dr. Manley was able to show that his brain suffered from no abnormalities. The player could return to the field. While he chose to retire, having solid data allowed him to make an educated decision.

Soon, coaches and teams will have the ability to test their players. Entrepreneurs like Danny Crossman, the CEO and founder of Shockbox Impact Alert Sensors, is bringing the technology of a helmet-mounted sensor for the military to alert soldiers when they may have suffered a concussion to the consumer market. With the Shockbox, a small sensor that sticks to helmets will transmit acceleration data to a coach’s Smartphone or tablet. The device works like a smoke alarm—suggesting, but not proving, that you suffered a concussion-causing hit.

This hard data will give coaches the power to take someone off the field. Without it, “an athlete is always going to say he’s okay,” says Hoyda. I did. Sinead did. The NFL guys do. “Some of it is lying, some is just the fact that they don’t know what’s going on,” Hoyda adds.

Something like this would have kept Sinead off her bike. But it wasn’t until after her seventh hit that she took a break: 6 months. (Dr. Manley sometimes suggests athletes consider retirement after three concussions.) At night, she slurred her words. At first, she could hardly speak—the damage to her brain was that extensive. She spent most of her time in bed. But she slowly recovered, and still wanted to race. Because of her history, coaches on the U.S. National Team required her to pass a doctor’s test. And even though she was in no condition to ride, the test was easy for her—she’d taken it multiple times already.

So she returned to the sport one last time, qualifying for nationals, and leading her team to victory on the first day. But it was how they won that turned heads. Ordinarily, riders rotate to stay out of the wind, but as the intensity increased, Sinead’s vision blurred. To avoid crashing into her teammates, she rode at the front—like one runner racing the entire relay for her team.

The next day of competition, her body had suffered enough. The migraines were unbearable. She was vomiting on the side of the road, and though she had raced the entire season for that one day, she sat out.

Seven concussions down the road, Sinead started listening. When will we?

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